Taha Diaa-Eldin, Raheem Ali Abdel, Aljarbou Abdulhkam, Bahdilh Salem, Alrubat Abdelkarim, Alowidah Ibrahim
Urology Department, King Saud Medical City, Riyadh, Saudi Arabia; Urology department, Kafrelsheikh University, Egypt.
Urology Department, King Saud Medical City, Riyadh, Saudi Arabia; Urology Department, College of Medicine, Tanta University, Tanta, Egypt.
Int J Surg Case Rep. 2021 Aug;85:106180. doi: 10.1016/j.ijscr.2021.106180. Epub 2021 Jul 12.
Genitourinary trauma secondary to a gunshot wound is uncommon as it only occurs in about 10% of cases. We present a case of a gentleman who suffered a gunshot wound to the kidney.
A 28 year old man presented with irritative lower urinary tract symptoms (LUTs) since three months. The medical history was irrelevant. He is known case of neurogenic bladder maintained on regular clean intermittent catheterization (CIC). He has history of gunshot to the back since few years that resulted in spinal injury. CTUT showed retained bullet inside the right kidney that look alike hyperdense renal stone, Moreover, multiple vesical stones. The vesical stones were treated with cystolitholapaxy. Given that the patient is asymptomatic, conservative management for the retained right renal bullet is the feasible option.
Based on the ASST classification, renal gunshot injury results in a grade IV injury. Abdominal exploration was reserved only in selected scenarios. Gunshot injuries to the kidney are commonly associated with thoracic and abdominal injuries. Gunshot injuries may be caused by low-velocity or high-velocity bullets. Given the paucity of cases reported in the literature, it is not obvious what is the optimum management of such patients with a retained renal bullet? We present the radiological findings and a clinical case summary as well for those who have Grade IV kidney injury and retained bullet managed conservatively.
Retained renal bullet post gunshot injury to the back is unusual presentation. A characteristic star-like pattern produced by lead shots and not by "stone," consisting of plastic detonating cap will aid the urologist to differentiate retained renal bullet from renal stone. In such scenario, asymptomatic renal bullet look alike renal stone doesn't necessitate treatment.
枪伤继发的泌尿生殖系统创伤并不常见，仅发生在约10%的病例中。我们报告一例肾脏遭受枪伤的男性病例。
一名28岁男性自三个月前开始出现刺激性下尿路症状（LUTs）。病史无特殊意义。他是一名神经源性膀胱患者，通过定期清洁间歇性导尿（CIC）维持治疗。他几年前有背部枪伤史，导致脊髓损伤。CTUT显示右肾内有残留子弹，看起来类似高密度肾结石，此外还有多个膀胱结石。膀胱结石通过膀胱碎石术进行了治疗。鉴于患者无症状，对右肾残留子弹进行保守治疗是可行的选择。
根据ASST分类，肾脏枪伤导致IV级损伤。仅在特定情况下才进行腹部探查。肾脏枪伤通常与胸部和腹部损伤相关。枪伤可能由低速或高速子弹引起。鉴于文献报道的病例较少，对于有残留肾脏子弹的此类患者，最佳治疗方法尚不明确。我们还展示了IV级肾损伤且残留子弹保守治疗患者的影像学表现和临床病例总结。
背部枪伤后肾脏残留子弹是一种不寻常的表现。由铅弹而非由包含塑料雷管的“结石”产生的特征性星状图案将有助于泌尿外科医生区分残留肾脏子弹与肾结石。在这种情况下，无症状的类似肾结石的肾脏子弹不一定需要治疗。
